HEART BEAT/Maurice Neligan: "He had been eight years upon a project for extracting sun beams out of cucumbers, which were to be put into vials hermetically sealed, and let out to warm the air in raw inclement summers." (Swift, Gulliver's Travels, A Voyage to Laputa)
Any resemblance to the PPARS debacle is, I am sure, purely incidental, and in any case the consultant in this case was the highly respected firm of Fiddle and Diddle, who I believe are no longer extant. Nonetheless, there are striking similarities in the usefulness of both projects and if you throw in the second computer system, the Will o' the FISP, or should that be Wisp?, we really qualify as one of the most gullible people on earth.
Meanwhile, the patients remain on trolleys in distressing numbers and we persist in telling everybody that the National Treatment Purchase Fund is a great idea. We know nothing about this fund, save what we are told and there is no independent verification on how and where this money is spent and whether value for money is obtained.
I personally feel that such monies should be properly invested where it belongs in the public system and the waiting lists tackled that way.
Apparently the Taoiseach, speaking in the Dáil, told his good friend Maurice Neligan (me) that I had been wrong in alluding to the 100,000 or so employees in the health service and that there were in fact about 145,000 thus employed.
I accept of course without reservation the correction of my good friend the Taoiseach. Sadly, however, it actually seems to make the whole situation worse. It is a vast number of people to provide a palpably inadequate service.
If, at guess, we add another 25,000 working in the private health sector, it would appear to me that out of a workforce of approximately 2,000,000, about one in 12 is employed in the delivery, or rather non-delivery, of healthcare. It gets worse. I heard a gentleman from The Health Services Employers Agency (HSEA) assuring the Impact trade union that there would be no bar on further employees to deal with the issue of the additional doctor-only medical cards.
Meanwhile, manpower shortages in the front-line medical and nursing disciplines remain unfulfilled. Dare one suggest that redeployment from the vast army already employed is the proper way to go, and while we are at it, could we establish whether we need such an army and whether they are properly divided among the front line and the often very unproductive rear echelons?
Fascinating as these subjects undoubtedly are, I wish to return to writing about a medical lifetime. I had wandered off into these intriguing byways whilst I had been describing the initial part of my medical life as a surgical intern in the Mater hospital, Dublin.
By now it was autumn, and there are all sorts of autumns, of years, of lives, possibly even of governments. It is a busy time in hospital. Summer vacations are over, and units begin to function again at full capacity. Formal teaching resumes and the intern's life becomes even busier. In writing this I need hardly remind you that I am writing about the "olden days", when the hospital was run by the Rev Mother, Rev Matron and the medical board. The whole institution was clean and tidy, there were no patients waiting on trolleys in the A&E department. The system worked, and we didn't even have an ethics committee.
For me, personally, life became even busier if that was possible. As my consultant was the professor of surgery, as well as chief of the cardiac surgical programme, multiple diverse activities filled my days.
From my vantage point at the foot of the ladder, it seemed that everything landed on my head. Admitting and looking after the unit patients, covering for your opposite number comprised the basic work. Writing theatre lists, organising teaching clinics and deploying the unit's students also had to be done. The teaching clinics involved persuading patients to take part in formal teaching sessions, often in the main lecture theatre.
The patients for the clinics were chosen by the consultants on the basis of a good medical history or physical signs of their condition. To the intern was left the task of explaining to the patient what it was all about and seeking their co-operation.
Almost always this was freely given and indeed many such patients knew more about their illness and physical condition than the tyro doctors under instruction. Occasionally you were met with a flat refusal, often couched in dramatic terms; "which part of **** off do you not understand doctor". Your bedside manner already fragile enough would wobble slightly and, despite your bitten tongue, you respected their wishes.
Returning to the chief with the news that the patient would not take part was invariably greeted by the conveying of the sentiment that you had not approached the patient correctly. The worst possible outcome was that the consultant would then make an approach and this would be acceded to graciously.
It strengthened our impression of those smooth talking lazy bastards of consultants who took all the money while we did all the work.
Our open heart surgery programme resumed, with all its trials and tribulations, and the shorter and colder days brought a new spectrum of illness to the hospital and leisure time became a rarity to be cherished. The interest, indeed the fascination, remained undiminished.
Maurice Neligan is a cardiac surgeon